Navigating the IV Fluid Shortage: What Hospitals and Clinicians Need to Know

Intravenous (IV) fluids are essential in medical treatments, especially for managing hydration and electrolyte imbalances in patients. However, hospitals in Australia are currently facing a shortage of IV fluids due to global supply issues. This blog provides an overview of the situation, including recommendations for conservation and safety measures.

Understanding the Shortage
The Therapeutic Goods Administration (TGA) has announced ongoing shortages of IV fluids from key suppliers, including Baxter Healthcare, B. Braun, and Fresenius Kabi. The shortage is primarily impacting saline (0.9% Sodium Chloride) and Compound Sodium Lactate (Hartmann’s solution) in various bag sizes. Contributing factors include global supply limitations, increased demand, and manufacturing issues.

To mitigate the impact, the TGA has approved alternative overseas-registered IV fluids under Section 19A of the Therapeutic Goods Act 1989. Hospitals and clinicians can access these alternatives through the TGA Section 19A approvals database?.

Key Conservation Strategies
To optimize IV fluid use during this shortage, the Australian Commission on Safety and Quality in Health Care (ACSQHC) has provided a comprehensive fact sheet on conservation strategies. Here are some essential guidelines:

- Remove VADs When Not in Use: Remove vascular access devices (VADs), or keep them locked and capped, when they’re not actively required to minimize unnecessary fluid use.
- Switch to Oral Therapy or Alternative Routes: Frequently review patients receiving IV infusions. Whenever possible, switch to oral or enteral administration, especially for medications like electrolytes, analgesics, and high-bioavailability antibiotics.
- Administer via IV Push When Possible: For compatible medications, administer via IV push injection instead of continuous infusions to reduce fluid usage.
- Use Ampoules in Place of Small Volume Bags: Where feasible, use 10 mL or 20 mL sodium chloride 0.9% ampoules for medication preparation (e.g., in syringe drivers) instead of smaller volume IV fluid bags.
- Prioritize 500 mL Bags for Specialty Uses: Reserve 500 mL sodium chloride 0.9% bags for priority settings like arterial lines or specialized infusions

Safety Considerations
During this period, it’s important to ensure safe practices when using alternative IV fluid products:

1. Risk of Air Embolism: Some Section 19A-approved IV bags may contain higher levels of residual air, increasing the risk of air embolism. It’s crucial to use in-line air detection devices or inspect bags thoroughly before use.

2. Storage and Stock Management: Limit stock levels in clinical areas and regularly assess supply. Avoid re-spiking or reusing IV bags, and ensure compatibility between fluids and medications.

For further details on IV fluid conservation, please refer to the ACSQHC fact sheet on conservation strategies and safety considerations and the TGA’s page on IV fluid shortages.